CA3086062A1

CA3086062A1 - Delivery device, delivery system, stent graft and a support structure

Info

Publication number: CA3086062A1
Application number: CA3086062A
Authority: CA
Inventors: Nathalie FENOUIL; Perrine CHAFFOTTE-GLUZIKI; Jean-Baptiste POURCHET
Original assignee: Kardiozis SAS
Current assignee: Kardiozis SAS
Priority date: 2017-12-19
Filing date: 2018-12-19
Publication date: 2019-06-27
Also published as: US20230320878A1; CN111787888A; AU2018390865A1; WO2019122944A1; SG11202005665VA; JP2021506447A; US11648141B2; WO2019122013A1; EP3727214A1; BR112020012303A2; CN111787888B; KR20200123093A; RU2020123734A; MX2020006426A; US20210315720A1

Abstract

According to one aspect of the invention, it is suggested to provide a delivery device (1) for an endoprosthesis (2). The endoprosthesis (2) is preferably an endoprosthesis for treating an aneurysm. The delivery device (1) comprises an outer sheath (3) and an inner tube (4). The inner tube (4) is arranged within the outer sheath (3) and at least one restraining tube (5, 30). The restraining tube (5, 30) is for holding the endoprosthesis (2) in a compressed configuration. The restraining tube (5, 30) is arranged between the outer sheath (3) and the inner tube (4). The outer sheath (3), the inner tube (4) and at least one restraining tube (5, 30) are coaxial. The restraining tube (5, 30) includes at least one axial elongation (6) extending from a distal end portion of the restraining tube. The at least one axial elongation (6) is adapted to be laced through portions of the endoprosthesis (2).

Description

Delivery device, delivery system, stent graft and a support structure The present invention relates to a delivery device, a delivery system, a stent graft and a support structure according to the preambles of the independent claims.
In particular, the present invention concerns devices used for the treatment of vascular aneurysms. Vascular aneurysms are the result of abnormal dilatation of a blood vessel, usually result-ing from disease and or genetic predisposition. The disease and/or genetic predisposition weakens a wall of the blood vessel and allows the wall to expand outwardly thereby forming a bulge.
While aneurysms could occur in any blood vessel, they are most common in the aortic arch, the abdominal aorta and the iliac ar-teries. The majority of aortic aneurysms occur in the abdominal aorta, usually beginning below the renal arteries and often ex-tending into one or both of the iliac arteries.
Aneurysms may be treated by inserting an endoprosthesis such as a stent graft into the dilated vessel. The stent graft is an-chored above dilated part of the vessel and comprises a graft which bypasses the dilated vessel. This stent graft may be im-planted with a catheter in a minimally invasive procedure.
US 7,160,318 B2 discloses a modular stent graft assembly for re-pairing a ruptured abdominal aorta aneurysm. The assembly can be selected from an inventory containing a set of delivery systems of four sizes of aortic extend grafts and a set of delivery sys-tems of four sizes of iliac section grafts, that accommodate a large majority of aneurysm size and delivery systems.

2 During the implantation of stent grafts a controlled release is preferable, in order to ensure a proper positioning of the stent graft at the implantation site.
US 7,264,632 B2 suggests a controlled stent graft deployment de-livery system. The delivery system comprises a cap coupled to a distal end of an inner tube. The cap is configured to retain at least a portion of a proximal portion of its stent graft in a radial compressed configuration. Upon a controlled axial move-ment between an outer tube and the inner tube and therefore the cap, the proximal end of the stent graft is released from the cap and allowed to expand. The whole system is relatively com-plicated and the cap has to be pushed distally in order to re-lease the stent graft.
One object of the invention is to overcome the disadvantages of the prior art and in particular to provide a reliable delivery device, which is easy to handle and allows a precise and simple placement of the endoprosthesis.
Herein, the directions proximal and distal with regard to the delivery device are defined in reference to an operator, in par-ticular a medical professional operating the delivery device.
Proximal is a direction pointing towards the operator. Distal is a direction pointing away from the operator.
With regard to the endoprosthesis the directions are defined in regard to a patient, in which the endoprosthesis is implanted.
Proximal is then defined as a direction pointing towards a cen-tre of the body, i.e. a direction towards the heart of the pa-tient. Distal is a direction pointing away from a centre of the body i.e. away from the heart of the patient. Depending on the mode of implantation, e.g. trans-apical or trans-femoral, the

3 terms proximal and distal may refer to opposite directions with respect to the endoprosthesis as compared to the delivery de-vice.
It is suggested to provide a delivery device for an endoprosthe-sis. The endoprosthesis is preferably an endoprosthesis for treating an aneurysm. The delivery device comprises an outer sheath and an inner tube arranged within the outer sheath. The device further comprises at least one restraining tube. The re-straining tube is adapted to hold the endoprosthesis in a com-pressed configuration. The restraining tube is arranged between the outer sheath and the inner tube. The outer sheath, the inner tube and the at least one restraining tube are coaxial. The re-straining tube includes at least one axial elongation extending from a distal end portion of the restraining tube. The at least one axial elongation is adapted to be laced through portions of the endoprosthesis.
Compressed configuration as used herein includes partially com-pressed (i.e. partially expanded) and fully compressed configu-rations. When the endoprosthesis is fully released from the de-livery device it assumes an expanded configuration.
The delivery device is particularly suited for stent grafts for treating aneurysms. The delivery device is also suited for other endoprosthesis such as stented heart-valves.
With such a device, the endoprosthesis may be held in the com-pressed configuration by the axial elongations without requiring a complex mechanism. When the outer sheath is withdrawn, the en-doprosthesis will be kept in a (partially) compressed configura-tion by the at least one restraining tube. In such a configura-tion, the position of the endoprosthesis might be easily adjust-

4 ed to ensure a proper positioning at the implantation site. In the compressed configuration, the endoprosthesis does preferably not contact the vascular wall in order to not irritate any tis-sue during a potential repositioning. The endoprosthesis can then be released and allowed to expand by withdrawing the re-straining tube. When the restraining tube is withdrawn, the axi-al elongation is withdrawn from the portion and therefore not laced anymore through the portion. Therewith, no compression force is acting on the endoprosthesis and the endoprosthesis is allowed to (fully) expand.
The device may further comprise a handle portion. The restrain-ing tube may extend to such a handle portion. The distal end portion of the handle may be a distal end of the restraining tube. A handle portion allows an easy and reliable withdrawing of the restraining tube(s) and therefore allows reliable, con-trolled expansion of the endoprosthesis.
The elongations are preferably integrally formed with the rest of the restraining tube. Integrally formed restraining tubes provide a simple and cost effective variant of restraining tubes. Alternatively, the elongations might be coupled to the rest of the restraining tubes, e.g. through gluing or moulding.
The inner tube, the outer sheath and the distal tip may comprise or be made of a plastic material. Exemplary materials for suita-ble plastics are Pebax, PEEK and PTFE. Alternatively, other bio-compatible materials such as metal (alloys) might be used.
In a preferred embodiment, the at least one restraining tube in-cludes multiple elongations. The multiple elongations extend from the distal end portion of the restraining tube. Preferably, the restraining tube comprises two or three or four or five or more elongations. The endoprosthesis may be held in the com-pressed configuration at multiple portions. Thus, the endopros-thesis can be held more stably with such an arrangement. The elongations may be distributed, preferably evenly, along the

5 circumference of the restraining tube.
A further aspect of the invention relates to a catheter with an inner tube and a tip. The tip may form a cavity that extends from a proximal side in a distal direction and a member, prefer-ably a harpoon member is arranged slidably in the cavity. The member may be suitable for holding a stent in compressed config-uration in a first position and release the stent in a second position. The member may be tubular and arranged slidably on the inner tube. The member may be arranged partly, preferably only partly, in the cavity. The cavity may have an entry that is smaller in cross-section than the cavity and/or the cavity may be at least partly radially offset to the entry. Thereby, with a suitably formed member, the member can be slidably retained, while the member cannot be lost.
In one embodiment, the restraining tube comprises a harpoon mem-ber with a base and an arm extending from the harpoon member.
The base and arm may be adapted to receive the stent in a gap formed in between base and arm. The gap may be closed by the tip, in particular a proximal extension from the tip. The har-poon member may be held slidably by the tip. The base of the harpoon member may comprise a flange. The flange may be slidably retained by a cavity in the tip. The harpoon member may inte-grally formed with a handle portion connecting part or may be formed as a separate part.
The harpoon member may be held in a cavity formed between the proximal extension of the tip and the inner tube. The arm may

6 extend along a longitudinal direction of the catheter. The arm of the harpoon member is laced through an opening in the stent.
The cavity may have an entry with a smaller cross-section than the cavity. The entry may have a smaller cross-section than at least a part of the base. The harpoon member may have a tubular form and may include one or more arms, in particular three, four five or six arms or more extending from it.
A proximal side of the harpoon member may be inclined. The prox-imal side of the harpoon member may have rounded edges. Thereby, the walls of a vessel of a patient are protected from injury, in particular from the edges of the tip or the harpoon member it-self.
In a preferred embodiment, the device comprises a distal tip.
The distal tip is attached to a distal end of the inner tube and comprises at least one recess. The at least one recess is adapted to receive at least one of the elongation(s) of a re-straining tube.
The recess preferably extends circularly around the distal tip.
The recess preferably extends from a proximal side of the tip in a distal direction. The recess may be adapted to receive the elongations of one or two or more restraining tubes. Preferably, the recess is adapted to receive all of the elongations of the restraining tubes, if there are multiple. The recess holds the restraining tube in place, i.e. with the extension laced through the portion and therewith prevents the endoprosthesis from sepa-ration. The recess therefore aids to hold the endoprosthesis in the compressed delivery portion. Upon moving the restraining tube, the restraining tube is then withdrawn from the recess and the endoprosthesis is deployed.

7 In a preferred embodiment, the at least one restraining tube is releasably engageable to the distal tip by engagement of at least one of these elongations in one of the at least one recess of the proximal tip. Thereby, the elongations may be held se-curely to the distal tip.
The device may comprise a first and a second restraining tube, preferably only the first and the second restraining tube and the distal tip a first recess and a second recess. Preferably, both recesses extend circularly around the distal tip. The first recess is adapted to receive at least one of the elongation(s) of the first restraining tube. The second recess is adapted to receive at least one of the elongation(s) of the second re-straining tube. Thereby, two restraining tubes can be held in the distal tip by separate recesses.
In order to implant the endoprosthesis, both restraining tubes are withdrawn such that the endoprosthesis is no longer com-pressed by the restraining tubes. Therewith, the endoprosthesis is allowed to expand.
In a preferred embodiment, the delivery device comprises exactly two restraining tubes.
The first restraining tube might be laced through an opening on the proximal portion of the endoprosthesis; the second restrain-ing tube might be laced through a distal portion of the endo-prosthesis. Therewith, the whole endoprosthesis is reliably kept compressed and secured to the delivery device.
The second recess preferably extends from a proximal side of the tip in a distal direction. The second recess is preferably adapted to receive all of the elongations of the second re-

8 straining tube. The second recess in the distal tip may be posi-tioned radially outwards in relation to the first recess.
In a preferred embodiment, at least one of the elongations in-cludes at least one attachment element adapted to be engaged with a corresponding element of the endoprosthesis. Preferably, each elongation comprises such an attachment element. Prefera-bly, the attachment element is a slot extending from a distal end of the axial elongation(s). The slot(s) may have a length of 5 to 15 mm. In a preferred embodiment, they have a length of 8 to 12 mm, particularly preferred about 10 mm.
Preferably, each elongation comprises one attachment element.
The corresponding element is preferably an anchor pin. Thereby, the endoprosthesis may be fixed to the restraining tube a pre-cise location, which enables a precise placement of the endo-prosthesis.
Preferably, the corresponding element is arranged at the por-tion. The elongation is laced through the portion and the corre-sponding element can directly engage the attachment element of the elongation. With a slot and a pin, a rotational secured po-sition can be achieved. Further, with a slot having an end adapted to be brought into contact with the pin, the relative axial position in one direction between elongation and the endo-prosthesis is also secured.
In a preferred embodiment, the first restraining tube is adapted to be laced through a proximal portion of the endoprosthesis, in particular through proximal arches. Thereby, a proximal portion of the endoprosthesis can be held.

9 Alternatively, the first restraining tube is adapted to be laced through a proximal portion of the endoprosthesis, in particular through proximal arches. Thereby, a proximal portion of the en-doprosthesis can be held.
In one embodiment, a second restraining tube is adapted to be laced through a distal portion of the endoprosthesis. In a pre-ferred embodiment, the second restraining tube is adapted to be laced through a proximal part of a graft of the endoprosthesis, in particular through a repositioning hole at the proximal part of the graft. Thereby, a distal portion of the endoprosthesis may be held by the delivery device. This facilitates reposition-ing the endoprosthesis during implantation.
With a first and a second restraining tube laced through a prox-imal and a distal portion, respectively, the whole endoprosthe-sis can reliably be kept compressed.
In a preferred embodiment, the first and the second restraining tube each include multiple elongations extending from their re-spective distal end portions. The elongations of the second re-straining tube are longer in an axial direction of the restrain-ing tubes than the elongations of the first restraining tube.
Thereby, the axial elongations of the second restraining tube can be laced through a distal portion of the endoprosthesis and attached to a distal part, preferably a distal tip, of the de-livery device. The shorter elongation(s) can be laced through a proximal portion and therewith allowing a reliable compression of the endoprosthesis. The distal portion of the endoprosthesis may be a distal portion of a stent or a distal or proximal por-tion of a graft.

In a preferred embodiment, the first restraining tube is at least partially arranged within the second restraining tube. At least a proximal part of the first restraining tube may be ar-ranged within the second restraining tube. Further, the elonga-5 tions of the second restraining tubes may be at least partially arranged within the elongations of the first restraining tube.
Thereby, the two restraining tubes use less space and the en-gaged endoprosthesis may be compressed to a smaller delivery state.
In a preferred embodiment, the elongations comprise or made of a biocompatible material. Preferred materials are in particular a metal and/or plastic. Particularly preferred materials are stainless steel (inox) or a nickel titanium alloy such as nitin-ol or PEEK or a chrome cobalt alloy.
According to another aspect of the invention, it is suggested to provide a delivery system comprising a delivery device as de-scribed hereinabove and an endoprosthesis. The endoprosthesis comprises a stent. The elongation(s) of at least one of the re-straining tubes is laced through a portion of the endoprosthe-sis.
The endoprosthesis may be self-expandable. Therewith, a with-drawal of the retaining tube will directly result in an expan-sion to the desired shape.
In particular, the delivery device comprises multiple elonga-tions which are laced through portions of the stent.
By engaging the stent, which forms a relatively rigid part, a reliable compression of this portion of the endoprosthesis can be achieved through the lacing of the elongations.

In a preferred embodiment, the stent comprises arches, which are formed by struts. The elongations of a first restraining tube are laced through arches of the stent. The arches are preferably arranged at a proximal end of the endoprosthesis. Thereby, the proximal end of the endoprosthesis may be securely held. The arches might also be formed at another portion of the stent such as the distal portion. The elongations may be laced through an end portion of the endoprosthesis, which is closest to the dis-tal tip of the delivery device.
The end of the endoprosthesis through which the elongations are laced may depend on the delivery approach. In a retrograde ap-proach the elongations may be laced through a proximal end of the in the prosthesis. In an antegrade approach the elongations may be laced through a distal end of the endoprosthesis.
In a preferred embodiment, the endoprosthesis comprises a graft.
The elongations of the second restraining tube are laced through the graft of the endoprosthesis. The graft is preferably ar-ranged at least partially distally to the stent. The elongations are preferably laced through pre-formed openings formed in the graft. Alternatively, the elongations may be laced directly through the graft thereby forming the openings. A distal portion of the endoprosthesis may therewith be kept compressed and pre-cisely placed. Further the endoprosthesis may be repositioned as long as the second restraining tube is engaged.
In a preferred embodiment, the elongations of a first and/or a second restraining tube are laced through struts of the stent forming a ring. The ring may extend radially inwardly from the stent or the graft or a second stent in the graft. A lacing through a ring of a stent provides a reliable securing of the stent to the restraining tube and therewith a reliable compres-sion.

The lacing trough the ring might be in addition to the lacing through the graft and/or arches as described hereinbefore.
In a preferred embodiment, the elongations of a second restrain-ing tube are laced through a distal part of the endoprosthesis.
Alternatively, they might be laced through another portion i.e.
a middle or the proximal portion.
In a preferred embodiment, the stent includes at least one an-chor pin. The delivery device includes at least one elongation, wherein the at least one of the elongation(s), preferably each elongation, comprises one or more slots. At least one of the slots is operatively engaged or engageable with the at least one anchor pin.
Therewith, a position of the endoprosthesis can reliably be se-cured as described hereinbefore.
In a preferred embodiment, one or more anchor pins are arranged at an apex, preferably a proximal apex, of the arches. Prefera-bly, the apex forms a proximal end of the endoprosthesis. Pref-erably, each apex comprises at most one anchor pin. Preferably, the anchor pin is arranged at a proximal end of the endoprosthe-sis.
In addition to or alternatively to the engagement with slot(s) of the elongations, the endoprosthesis pins might facilitate an-choring of the endoprosthesis to a wall of a body vessel by en-gaging the tissue.
In a preferred embodiment, the endoprosthesis includes an outer cover, preferably a graft. The outer cover covers a part of a stent ring. The stent ring comprises at least one repositioning opening. An elongation of at least one restraining tube is laced through the at least one repositioning opening. If a second re-straining tube is present, the elongations of the second re-straining tube are preferably laced through the repositioning opening. Thereby, while withdrawing the outer sheath the distal portion of the endoprosthesis is more compressed than the proxi-mal portion. This facilitates a repositioning of the endopros-thesis at least in the distal direction.
The outer cover may be realized as a graft. The repositioning opening may be realized as a repositioning hole. The reposition-ing opening is preferably at a proximal part of the cover. Par-ticularly preferred, the opening is provided by the stent.
Thereby, high positioning accuracy is achieved by preventing elastic recoil of the stent of the graft. Such a repositioning opening is advantageous for a heart valve or a thoracic endo-prosthesis.
In one embodiment the repositioning opening may be disposed at a distal end portion of the stent. The repositioning opening may be disposed distally of the distal edge of the cover. Such a re-positioning hole is advantageous for abdominal endoprosthesis.
One object of the invention is to provide a delivery device, which allows a secure release of an endoprosthesis and prevents a user from accidentally releasing the endoprosthesis.
According to another aspect of the invention, it is suggested to provide a delivery device for an endoprosthesis comprising a handle portion. The handle portion comprises a body, a first gripping portion for retracting an outer sheath of the delivery device, and a separate second gripping portion for retracting the outer sheath. The first gripping portion comprises a ring, wherein said ring is rotatable around a longitudinal axis of the body such that upon rotation of the ring the outer sheath is withdrawn. The separate second gripping portion is axially con-nected or connectable to the outer sheath. The second gripping portion is slidable relatively to the body along the longitudi-nal axis of the body such that the other sheath is retractable by pulling the second gripping portion longitudinally.
The ring may also be open and in particular C-shaped. Herein, connected is to be understood as directly or indirectly connect-ed.
With such a device, the other sheath may be retracted at a slow controlled mode, by rotating the first gripping portion and in a fast mode with the second gripping portion. Since the two grip-ping portions are separated, a risk of an accidental use of the non-intended gripping portion is minimized.
In a preferred embodiment, the handle portion comprises an inner connecting member. The inner connecting member is rotatably con-nected or connectable to the second gripping portion and con-nected or connectable to the outer sheath. The inner connecting member may be cylindrical, in particular tubular. The inner con-necting member may be freely rotatable connected to the second gripping portion such that rotation of the inner connecting mem-ber does not result in a rotation of the second gripping por-tion. This allows a slow retraction with the first gripping por-tion and a rotation of the inner connecting member without a ro-tation of the second gripping portion.
In a preferred embodiment, the inner connecting member comprises one or two or more cam(s). The cam(s) extend(s) radially out-wardly. The cam(s) is/are engageable in a circumferential recess of the second gripping portion. Alternatively the one or two or cam(s) extend(s) radially inward from the second gripping por-tion and is/are engageable on a circumferential recess of the 5 inner connecting member. Thereby, the inner connecting member may be connected freely rotatable to the second gripping portion such that rotation of the inner connecting member does not re-sult in a rotation of the second gripping portion. At the same time, axial forces are transmitted from the second gripping por-

10 tion to the inner connecting member. The proposed connection(s) allow a low friction, easy to produce and reliable connection.
In a preferred embodiment, the inner connecting member is rotat-ably (i.e. freely rotatable) connected or connectable to the 15 outer sheath. Thereby, a rotation of the inner connecting member does not result in a rotation of the outer sheath.
In a preferred embodiment, the inner connecting member is tubu-lar with an inner lumen. The inner lumen comprises a circumfer-ential recess for receiving a cam of the outer sheath. Alterna-tively one or two or more cams extend into the inner lumen for rotatably attaching the outer sheath to the inner connecting member. Thereby, a rotatable connection may be formed between the inner connecting member and the outer sheath.
The rotatable connection allows a transfer of axial forces from the handle portion to the outer sheath, while torsional moments are not transferred. Alternatively to the above described cams of the outer sheath, the outer sheath may comprise a radially inwardly extending recess.
In a preferred embodiment, the second gripping portion comprises a tubular outer connecting member. The outer connecting member is slidably arranged on a, preferably threaded, tube. Thereby, the second gripping portion may slide along the longitudinal ax-is of the handle portion.
By sliding the outer connecting member, the outer sheath may be withdrawn without rotation of the tube in the fast mode. The outer sheath can be withdrawn faster than through rotation of the first gripping portion.
In a preferred embodiment, the handle portion comprises a threaded tube. The threaded tube is disposed between a second gripping portion and the inner connecting member. The second gripping portion is connected or connectable to the inner con-necting member through axially extending slotted holes in the threaded tube.
Preferably, the inner connecting member is connected to the out-er connecting member with cams. Thereby, the inner connecting member and the outer sheath are connected to the second gripping portion, allowing a transfer of axial forces from the second gripping portion to the outer sheath.
In a preferred embodiment, the first and second gripping portion may be releasably coupled. Thereby, when actuating the second gripping portion, the first gripping portion may be uncoupled and does not move (i.e. no rotation) when the second gripping portion slides. This reduces the resistance (i.e. friction loss-es) when actuating the second gripping portion and improves the ease of use. The same may apply vice versa for the first grip-ping portion.
In a preferred embodiment, the first or second gripping portion comprises a selection mechanism. The selection mechanism com-prises a selection element, preferably a button. The selection element is moveable between an open position and a locked posi-tion. In the locked position the second gripping portion is di-rectly or indirectly engaged to the first gripping portion such that the outer sheath is retractable by rotating of the first gripping portion. In the open position the second gripping por-tion is released from the first gripping portion such that the outer sheath is retractable by pulling the second gripping por-tion longitudinally relatively to the body.
The selection element is preferably biased towards the locked position. The bias is preferably achieved with a spring connect-ed to the body and the button.
In one embodiment the locked and the open position of the button may be identical (e.g. a monostable switch for toggling between locked and open position).
Thereby, a desired mode of use, i.e. fast (through pulling) or slow (through rotation), may be chosen by the operator. For ex-ample, during an implantation procedure of an endoprosthesis first the first gripping may be rotated and the outer sheath may be retracted relatively slowly, allowing a precise placement and potential adjustments. Once an end of the endoprosthesis is pre-cisely placed, the endoprosthesis may be released with the se-lection mechanism in the open position allowing a faster with-drawal of the outer sheath and therefore a fast release of the endoprosthesis from the outer sheath.
In a preferred embodiment, the handle portion comprises a threaded tube, which is disposed radially inwardly in relation to the second gripping portion. In a preferred embodiment the handle portion includes only one threaded tube allowing a simple setup. The threaded tube is preferably hollow. The threaded tube is aligned coaxially with the body of the handle portion. The second gripping portion is indirectly engaged to the first grip-ping portion via the threaded tube in the locked position and released from the threaded tube and the first gripping portion in the open position. Thereby, the first and second gripping portion may be easily coupled and decoupled depending on the de-sired mode of use.
In a preferred embodiment, the threaded tube is fixedly connect-ed to the first gripping portion or integral with the first gripping portion. Thereby, a rotation of the first gripping por-tion is transferred to the threaded tube and transformed to an axial movement of the outer sheath.
The threaded tube may be held rotably relatively to the body.
The first gripping portion may be in a fixed longitudinal posi-tion (i.e. no sliding along the longitudinal direction of the body). This results in a more clearly arranged device.
Alternatively, the first gripping portion may comprise an inner threading, which is operatively engaged to the threaded tube.
Through rotation of the first gripping portion, the threaded tube is moved axially. Preferably, the threaded tube is not ro-tatable. Thereby, the threaded tube and the second gripping por-tion in the locked position may be moved in an axial direction upon rotation of the first gripping portion.
In a preferred embodiment, the second gripping portion comprises one or two or more radially moveable contact element(s). The threaded tube comprises an outer threading. The contact ele-ment(s) is/are adapted to engage the outer threading in the locked position and is/are released from the outer threading in the open position. Thereby, the second gripping portion may be coupled to or released from the first gripping portion depending on the desired mode of use.
In a preferred embodiment, the one or two or more contact ele-ment(s) comprise(s) or is/are made of wire. Preferably, the wire is a plastic or metal wire, in particular a steel wire. The thickness of the wire may be smaller than a thread of the outer threading. The wire may be L-shaped or U-shaped. The wire may comprise one or two end portions at which it may be attached to the second gripping portion. The wire may be moveable partly or entirely radially to the threaded tube.
The wire provides a reliable solution to engage the second grip-ping portion with the outer threading.
In a preferred embodiment, the tubular outer connecting member comprises one or two or more radially extending through hole (s) The one or two contact element(s) is/are disposed at least par-tially in the one or two or more through hole(s). Thereby, the selection element may be easily and reliably connected to the outer threading with the contact element.
In a preferred embodiment, the selection element comprises a ra-dially moveable button. The button is operatively attached to the moveable contact element(s). Preferably, the button is fix-edly attached to the moveable contact element(s). The second gripping portion comprises a socket for holding the button. The socket may comprise an inner cut-out for the button. A length of the cut-out is shorter than a length of the button along an axi-al direction of the handle portion. Thereby, the button is se-curely held in the second gripping portion. Another advantage is that a radially outward movement of the button is limited by the shorter cut-out and that button is thereby secured to the rest of the handle portion. By pressing the button, the contact ele-ments are released from the threading thereby allowing a free sliding of the second gripping portion on the tube.

In a preferred embodiment, the contact elements, which are fix-edly attached to the button, form a stopper for the button.
Thereby, radially outward movement of the button may be limited.
Thereby, the button is secured to the rest of the handle por-10 tion.
In a preferred embodiment of all devices described hereinbefore, a handle portion comprises at least one release mechanism for releasably fixing a restraining tube to the handle portion. Each 15 release mechanism comprises a release element, preferably a but-ton or lever, which is moveable between an open and a locked po-sition. The release element is preferably biased towards the locked position. Preferably, the release element is biased by a release spring. In the locked position the restraining tube is 20 fixedly connected to the body of the handle portion. In the open position the restraining tube is adapted to be axially slid lon-gitudinally in relation to the body of the handle portion by re-tracting the restraining tube. Thereby, the restraining tube(s) may be fixedly attached to the body of the handle portion and may be released from the handle portion, when needed. The device may comprise a first and/or a second restraining tube.
The release mechanism may also be combined with a delivery sys-tem as described herein above.
Such a design prevents that the restraining tube(s) is/are unin-tendedly withdrawn. In the locked position, the restraining tubes cannot be withdrawn. Once the endoprosthesis is at the de-sired location, the release mechanism is moved into the open po-sition allowing withdrawal of the restraining element and there-fore expansion of the endoprosthesis.
In a preferred embodiment, the handle portion comprises two re-lease mechanisms for releasably fixing a first and second re-straining tube. Thereby, two restraining tubes can be held by the handle portion. The release mechanisms may be arranged at a distal end portion of the handle portion. Preferably, the re-lease mechanisms are arranged distally of the second gripping portion. Preferably, a first release mechanism is arranged dis-tally of a second release mechanism. The distal arrangement al-lows a comfortable activation, as the mechanisms are not too close to the body of the operator.
In a preferred embodiment, the handle portion and a restraining tube are connected by an actuation spring. The actuation spring is pre-stressed in a longitudinal direction of the handle por-tion such that upon opening the release mechanism the restrain-ing tube is retracted by the pre-stressed actuation spring.
Thereby, an operator, i.e. a medical professional, only needs to actuate the release element to automatically withdraw the re-straining tube. This allows a fast and easy withdrawal of the restraining tube.
In a preferred embodiment, the release mechanism comprises a stopper, preferably a ring, arranged to prevent moving the re-cess mechanism from the locked position the open position. The stopper is preferably disposed proximally to the release mecha-nism. The stopper prevents accidental movement of the release mechanism into the open position and therefore accidental axial movement of the restraining tube. To allow activation of the re-lease mechanism, the stopper has to be actively moved away from the release mechanism. The ring may be open, for example C-shaped. Thereby, the stopper may be removed from the handle por-tion.
In a preferred embodiment, the second gripping portion is dis-posed proximally of the first gripping portion. After rotation of the first gripping portion, the operator may pull the second gripping portion arranged closer to him. This is a more ergonom-ic mode of operation.
In a preferred embodiment, the body comprises a third gripping portion. The third gripping portion may not take part in the movement of the outer sheath and allows the operator to hold handle without the risk of unintentional movement. Hence, the handle portion can be securely carried without accidentally re-tracting the outer sheath.
The first and second gripping portion may be axially separated, in particular in an unretracted configuration of the outer sheath. This reduces a risk of accidentally actuating the second gripping portion.
In a preferred embodiment, the third gripping portion is dis-posed between the first and the second gripping portion along a longitudinal direction of the handle portion. This position has been found to be comfortable for the operator. Further, when ac-tuating the first gripping portion, there no risk of accidental-ly actuating the second gripping portion.
In preferred embodiment, the body comprises one or two or more axially extending slotted hole(s). The second gripping portion is at least partially arranged slidably in the slotted hole(s).

Another object of the invention is providing a stent graft, which allows a simple loading procedure.
It is suggested to provide a stent graft, preferably for treat-ing an aneurysm, with a collapsible and a re-expandable stent.
The stent is preferably a vascular or a heart stent. The stent comprises a proximal and a distal end. The stent further com-prises at least one hole to receive a wire or elongation for loading the stent into a delivery device. The stent further com-prises an outer cover covering a distal part of the stent. The at least one hole is disposed proximally of a proximal edge of the cover.
Wires may be laced through the at least one hole. The stent graft may be compressed into the collapsed configuration, by pulling the stent through a conical hole via the attached wires.
This provides an easy solution to compress stent grafts with ra-dially expandable stents. Further, the graft does not include holes.
In preferred embodiment, the at least one hole is disposed less than 2.5 mm proximally of the proximal edged cover. Preferably, the at least one hole is disposed between 1 mm and 2 mm proxi-mally of the proximal edge. The arrangement allows a pulling of the stent at a location close to the cover Such an arrangement prevents a leak through the loading hole (type 1 endoleak). Further, this arrangement allows a simpler stent design.
The stent may comprise or is made of a shape memory material.
Examples for shape memory materials are nickel titanium alloys such as nitinol and chrome cobalt alloys.

In a preferred embodiment, stent includes at least one pair of struts having a common apex and extending from the apex in a distal direction. The hole is disposed at the apex of the struts.
The provision of the hole at an apex allows an easy design of the stent as apexes already form circumferentially at least partly a hole.
In a preferred embodiment, the hole is formed in between the pair of struts and includes an open end formed by the pair of struts. The open end may be on a distal side of the hole.
In a preferred embodiment, the stent comprises three or four or five or more holes. Thereby, higher forces can be transmitted onto the stent graft. Further, the forces on the stent can bet-ter be distributed circumferentially avoiding any tilting of the stent.
In a preferred embodiment, the holes have the diameter of less than 1.5 mm, preferably less than 1 mm. In a particular pre-ferred embodiment, the holes have diameter between 0.7 and 0.8 mm. The diameter of the holes may be defined by a needle which is laces a wire through the holes. By providing small holes, there is not much space between the wire and the surrounding struts allowing a reliable movement.
In one embodiment, the proximal edge of the cover may be undu-lating. When the proximal edge is undulating, the holes are preferably not covered by the cover.

One object of the invention is to provide a simple support structure.
According to another aspect of the invention, it is suggested to 5 provide a support structure with thrombogenic elements for a stent graft. The support structure is sized and shaped to be mounted on the stent graft. The support structure comprises at least one strip of a fabric. A plurality of elongated thrombo-genic elements, preferably fibres, are attached to the at least 10 one strip. Thereby, a support structure may be provided inde-pendently of the stent graft and may be fabricated independently of the stent graft. The support structure is in particular sepa-rate from the stent graft. Such a support structure can be at-tached to the stent graft. Therewith, conventional stent grafts 15 can be provided with thrombogenic elements, if desired.
The thrombogenic elements are in particular shaped to be re-leased into an aneurysm. "shaped" may refer to a suitable mate-rial, thickness and/or length.
20 The support structure may have a length greater than the diame-ter of a stent graft to which the support structure is attached.
The length is in particular greater than a circumference of the stent graft. This allows a fast fixation of the support struc-ture to the stent graft. Further, this allows a preparation of 25 the stent graft by a surgeon at the site of the operation.
In a preferred embodiment, the support structure or the endo-prosthesis may comprise an attachment interface for attachment to the stent graft. The attachment interface may be formed by at least one of: hooks, ridges, a surface for adhesives, a layer of an adhesive or similar.

Thereby, the support structure may be selected for the patient.
For example, according to one further aspect of the invention a set may be provided with a stent graft and a plurality of sup-port structures. The support structures may vary in density, and/or diameter and/or length of the thrombogenic elements. De-pending on the size and the structure of the aneurysm, a suita-ble support structure may be chosen and attached to the stent graft. A further aspect of the invention may relate to a set with a plurality of support structures as described above.
The support structure may include a first part with thrombogenic elements for endoleaks and a second part with thrombogenic ele-ments for an aneurysm. The thrombogenic elements for the aneu-rysm are relatively longer. The thrombogenic elements may be denser, i.e. placed closer to each other, for the endoleak.
The thrombogenic elements may be adapted to prevent and endoleak or to treat an aneurysm.
In a preferred embodiment, the thrombogenic elements are sewed, in particular stitched, glued, welded or riveted to the at least one strip. Theses attachment methods provide a reliable attach-ment of the thrombogenic elements to the strip.
In a preferred embodiment, the thrombogenic elements comprise a first and a second end. The first and the second ends are both attached to the strip. Thereby, the thrombogenic elements form a loop. Thereby, with one thrombogenic fibre attached, two throm-bogenic fibres are extending from the strip increasing the vol-ume to be treated.
In a preferred embodiment, the elongate thrombogenic elements comprise a first and a second end wherein the first ends are connected to the strip and the second ends are realisably con-nected to one or two or more secondary strips. Therewith, the second end of the thrombogenic elements might, e.g. after im-plantation, be released from the secondary strip to extend fur-ther radially away from the first strip. Therewith, an interfer-ence of the thrombogenic elements during loading and implanta-tion of the stent-graft is minimized.
In a preferred embodiment, the at least one strip, preferably all strips, is formed by threads or fibres. Such materials have been shown to be durable and biocompatible.
In a preferred embodiment, the strip(s) is/are made of a syn-thetic fibre. The fibre may be a poly amide (PA), PET, PE, PTFE, FEP or PFA. Such materials have been shown to be durable and bi-ocompatible.
In a preferred embodiment, the support structure comprises only one strip. Thereby, a simple support structure can be provided.
In a preferred embodiment, the support structure comprises a plurality, preferably four, five, six, seven or more, of paral-lel strips. The parallel strips extend longitudinally and are transversely spaced apart. The longitudinal strips are intercon-nected by transversely extending strips. Thereby, the longitudi-nal and the transverse strips form a mesh.
In a preferred embodiment, the support structure comprises a longitudinally extending membrane, which is attached to the strips. In a preferred embodiment, the membrane is made out of or comprises a polymeric material, preferably FEP or PFA. The polymeric material may be PE, PA. Alternatively the membrane may comprise or is made of a natural material like silk.

In a preferred embodiment, the thrombogenic elements are at-tached to transversely outer strips, which extend longitudinal-ly. In one embodiment the thrombogenic elements are only fixedly attached to transversely outer strips. Thereby, the mesh may be attached on either side of the mesh to a stent graft.
According to another aspect of the invention, it is suggested to provide a stent graft comprising one or more body parts with a graft, wherein one or two or more support structures are ar-ranged on a radially outer surface of the graft.
In a preferred embodiment, the at least one support structure is sewn, glued or welded to the one or more body parts.
In a preferred embodiment, at least one support structure is wound helically around the one or more body part.
In a preferred embodiment, a longitudinal direction of at least one support structure is parallel to a longitudinal axis of the one or more body parts.
In a preferred embodiment, at least one support structure is wound circumferentially around the one or more body parts.
In a preferred embodiment, the stent graft comprises two or more body parts. A first tubular body part includes a proximal open-ing and two distal openings and a second tubular body part is attached to one of the distal openings. One or two or more sup-port structures are attached to the first and/or second body part.

In a preferred embodiment, two or more support structures, pref-erably four to eight support structures are arranged on the out-er surface of the one or more body parts. Particularly preferred two or more structures are arranged on each of the body parts.
Non-limiting embodiments of the invention are described, by way of example only, with respect to the companying drawings, in which:
Figure 1: is a schematic drawing of a delivery device according to the invention;
Figure 2: is a detailed view a distal portion of the delivery device according to figure 1;
Figures 3A and 3B are detailed views of a restraining tube;
Figures 4A and 4B are schematic drawings of a proximal part of a stent graft according to the inven-tion;
Figure 5 is a detailed view of a second embodiment of a distal portion of a delivery device according to the invention;
Figure 6: is a schematic drawing of a handle portion of a delivery device according to the in-vention;
Figure 7: is a second view of the delivery device ac-cording to figure 6;

Figure 8: is a schematic drawing of a first embodi-ment of the handle portion;
Figure 9: is a cross-section of a second embodiment 5 handle portion;
Figures 10A and B: are schematic drawings of an inner connect-ing member;
10 Figure 11 is schematic drawing of an outer connecting member;
Figure 12: is a schematic drawing of a release mecha-nism;
Figures 13A and 13B are schematic drawings of a deployment of an endoprosthesis with a first delivery de-vice;
Figures 14A and 14B: are schematic drawings of a deployment of an endoprosthesis with a second delivery device;
Figures 15A and 15B: are schematic drawings of a second embodi-ment of a distal portion of the delivery device; and Figures 16A to 17: are further schematic cross-sectional and perspective views of the distal portion of the delivery device shown in Figures 15A
and 15B.

Figure 1 shows a delivery device 1. The delivery device 1 com-prises a distal tip 8 and a handle portion 14. An operator, for example a medical professional, holds the device 1 at the handle portion 14. The direction proximal P and distal D are defined from the perspective of the operator. The handle portion 14 com-prises a first gripping portion 15 and a second gripping portion 16.
Further, the handle portion 14 comprises a third gripping por-tion 51. An outer sheath 3 extends in the distal direction from the handle portion 14. The first gripping portion 15 is ring shaped, rugged on its outer surface and allows the operator to retract the outer sheath 3 slowly. Therefore, the first gripping portion 15 is rotated around a longitudinal axis L of the deliv-ery device. Thereby, the outer sheath 3 is slowly retracted. The outer sheath 3 is made of a sandwich structure of PTFE and metal coils.
As the first gripping portion 15 is rotated the second gripping portion 16 slowly moves in the proximal direction. If the opera-tor wants to retract the outer sheath 3 faster, the operator may press a selection button 20 to decouple the second gripping por-tion 16 from the first gripping portion 15. The outer sheath 3 can then be retracted by pulling the second gripping portion 16 proximally. Once the selection button 20 is pushed, the second gripping portion 16 is decupled from a threaded tube 18. The se-lection mechanism is explained later in detail with reference to figure 9. Further, the delivery device 1 comprises a release mechanism 19, which is explained in detail with reference to Figure 12. Further details of the mode of operation are also discussed with reference to figures 6 and 7.

Figure 2 shows a detailed view of a cross section of a distal part of the delivery device 1. An endoprosthesis 2 is loaded in the delivery device 1. The endoprosthesis 2 is held in a com-pressed configuration within the delivery device 1 by the outer sheath 3. The outer sheath 3 extends from the handle portion 14 to the distal tip 8. An inner tube 4 is disposed coaxially with-in the outer sheath 3 and its proximal end is connected to the handle portion 14. At its distal end 9, the inner tube 4 is con-nected to the distal tip 8. The distal tip 8 and the inner tube 4 are made of Pebax.
The endoprosthesis 2 comprises a stent 22. At a proximal end of the stent 22 an anchor pin 13 is arranged. With regard to the endoprosthesis 2, the directions proximal and distal are defined with regard to a patient, in which the endoprosthesis 2 is im-planted. Thus, the directions proximally and distally, when re-ferring to the endoprosthesis 2 are defined opposite to the di-rections with regard to delivery device in these figures.
Further, the delivery device 1 comprises a restraining tube 5.
The restraining tube 5 is disposed between the inner tube 4 and the outer sheath 3. The restraining tube 5 is laced through arches of the stent 22 of the endoprosthesis 2 at a proximal end of the endoprosthesis 2. At its distal end 7, the restraining tube 5 is held in a first recess 10 of the distal tip 8. The first recess 8 extends circumferentially around the distal tip 8 and is located at a proximal side of the distal tip 8.
The distal end 7 of the restraining tube 5 is engaged in the first recess 10. Since it is held in the first recess 10, the endoprosthesis 2 is prevented from disengaging. The restraining tube 2 thus holds the stent 22 in a compressed configuration even when the outer sheath 3 is withdrawn. In the compressed configuration, the stent 22 may be delivered to an implant site and released there into an expanded configuration. A distal por-tion of the endoprosthesis 2 is held in the delivery device by the outer sheath 3. The distal portion is a graft 36. To release the endoprosthesis 2, first the outer sheath 3 is withdrawn. The endoprosthesis 2 will then partly expand but is kept in a partly compressed configuration by the restraining tube 5. To fully re-lease the endoprosthesis 2, the restraining tube 5 is withdrawn, first out of engagement with the recess 10 and then through the apex of the stent 22.
Figures 3A and 3B show the restraining tube 5 in detail. The re-straining tube 5 comprises a shaft 25. Five elongations 6 extend from the distal end of the shaft 25. These elongations 6 extend in a distal direction of the delivery device 1. The elongations 6 include distal ends, which form the distal end 7 of the re-straining tube 5. The distal ends 7 of the elongations 6 are in-serted into the first recess 10 (see Fig. 2). Further, each elongation comprises a slot 12. The slot 12 extends from the distal end 7 of the elongations 6 in a proximal direction. The slots 12 have a length of about 10 mm.
The slots 12 form an attachment element 11. The slots 12 are adapted receive the anchor pin 13 of the stent 22 in a loaded configuration (see Fig. 2). Thereby, the stent 22 is held se-curely in place. The slot 12 divides a distal portion of the elongations into two fingers 26. Each slot receives one anchor pin 13 of the stent 22. To release the anchor pins 13 from en-gagement with the restraining tube 5, the restraining tube 5 is simply retracted in a proximal direction. During the retraction, the elongations 6 are first disengaged from first recess 10 and then disengaged from the anchor pins 13. A proximal part of the endoprosthesis 2 is therewith released from the delivery device 1 and allowed to fully expand.
Figures 4A and 4B show a proximal portion of the endoprosthesis 2. The endoprosthesis 2 comprises the stent 22 and the endolumi-nal graft 36. The pins 13 are disposed at a proximal end 24 of the stent 22. Struts 23 extend from the proximal end 24 of the stent 24. The Struts 23 extend in a longitudinal direction of the stent 22. Two struts 23 meet at an apex, where one anchor pin 13 is arranged. Thus, the struts 23 form arches. The stent 22 of figures 4A and 4Bcomprises five such apexes, each with one anchor pin 13. The slots 12 (see figures 3A and 3B), receive the pins 13, when the stent is loaded in the delivery device 1.
In a distal direction the struts 23 meet with neighbouring struts. At the point where the arches meet, a hole for radio-paque markers 38 is formed. A loading hole 31 is arranged dis-tally from the markers 38. The endoluminal graft 36 and its proximal edge 37 are arranged even further distally. An undulat-ing structure is by struts 39, which extend from the radiopaque markers 38. The loading hole 31 is disposed distally of and in between two radiopaque markers 38 along a circumferential direc-tion. The loading hole 31 is formed within an apex 40 of two proximally extending struts 39. The hole 31 comprises an open end in a distal direction. When the stent is loaded into the de-livery device 1 a wire is laced through the loading hole 31 and then the wire is used to pull the stent through a conically ta-pering hole. Thereby, the stent is compressed and may be insert-ed into a delivery device.
Figure 5 shows a second embodiment of a delivery device 1'. The delivery device 1' is similar to the delivery device 1. In con-trast to the delivery device 1 shown in figure 2, the delivery device in figure 5 comprises a second restraining tube 30. The second restraining tube 30 is shaped like the first restraining tube 5 (see figures 3a and 3b). However the second restraining tube 30 does not include slots 12 and its elongations are longer 5 than the ones 6 of the first restraining tube 5. The elongations of the second restraining tube 30 are laced through reposition-ing holes 47 of the endoprosthesis 2.
Distal ends 67 of the elongations of the second restraining tube 10 30 are held in a second recess 29 of the distal tip 8. The sec-ond recess 29 is also arranged on a proximal side of the distal tip 8 and extends circularly around the distal tip 8. As can be seen in figure 5, repositioning holes 47 are disposed at a dis-tal part of the endoprosthesis 2. Thus the elongations of the 15 second restraining tube 30 extend at least from the reposition-ing hole 47 to the distal tip 8. The repositioning holes 47 are arranged distally of the stent 22 and in a proximal part of the graft 36. Fig. 5 only shows a part of the graft 36. The graft 36 extends further in the distal direction of the endoprosthesis 2.
A proximal part of the second restraining tube 30 is disposed between the first restraining tube 5 and the outer sheath 3. The elongations of the second restraining tube 30 are disposed in the radially inward second recess 29. Thereby, the second re-straining tube does not hold the stent 22 compressed but a more distal portion of the endoprosthesis.
Figure 6 shows the handle portion 14 in detail. The handle por-tion 14 comprises a body 46, the first gripping portion 15, the second gripping portion 16 and a third gripping portion 51. The third gripping portion 51 is part of the body 46 and does not take part in the withdrawal of the outer sheath 3. The first gripping portion 15 is arranged distally to the second and third gripping portions 16, 51. The first griping portion 15 is a ring with a rugged surface. Thereby, the operator can securely grip the first gripping portion 15. The body 46 comprises a first slotted hole 54 and a second slotted hole 54 on an opposite cir-cumferential side. The slotted holes 54 extend along an axial direction of the handle portion 14. Within the slotted hole 54, the threaded tube 18 can be seen. Further, the tube 18 also com-prises two axial extended slotted holes 41.
Figure 7 shows a second view of the handle portion wherein a distal part of the handle portion is seen in a cross section.
Within the hollow body 46 an inner cylinder 42 is arranged. The inner cylinder 42 is integrally formed with the first gripping portion 15 and connected to the threaded tube 18. The connection between the threaded tube 18 and the inner cylinder 42 and thus the first gripping portion 15 is fixed. Alternatively all parts, of threaded tube 18 in the cylinder 42 and first gripping por-tion 15 may be integrally formed. Thus, upon rotating the first gripping portion 15, the threaded tube 18 is also rotated around the axis of the handle portion. As can be seen from figure 7 the release mechanism 19 comprises a release lever, realized as arm 28.
Figure 8 shows a schematic drawing of functional principle of a first embodiment of the handle portion 14'. A first gripping portion 15' is ring shaped und comprises an inner threading 17.
The inner threading 17 is in operable connection with a threaded tube 18'. When the first gripping portion 15' is rotated, the threaded tube 18' is moved in a proximal direction. A second gripping portion 16' is releasably connected to the threaded tube 18'. The second gripping portion 16' is fixedly connected to an outer sheath 3' with a link 43. When the threaded tube 18' is moved, the second gripping portion 16' is also moved and the outer sheath 3' is ultimately retracted.
The second gripping portion 16' may be coupled the first grip-ping portion 15' with a wire 50 (see Fig. 9). When the second gripping portion is released from the threaded tube 18', the outer sheath 3' may be retracted by pulling the second gripping portion 16'.
A second embodiment of the handle portion 14 is described in de-tail with reference to figures 9, 10 and 11. Figure 9 shows a cross section of the handle portion 14 and the second gripping portion 16. A socket 60 is arranged on the body 46. The socket 60 holds the button 20 for releasing the second gripping portion 16 from the first gripping portion 15. The second gripping por-tion 16 further comprises an outer connecting member 49 (see al-so Fig. 11). Wires 50 are fixedly attached to the buttons 20 and engage the threading of the threaded tube 18. The wires 50 have a U-shape and enclose the threaded tube 18.
Fig. 11 shows a perspective view of the outer connecting member 49. The outer connecting member 49 comprises a tubular body 65.
The button 20 is connected to the outer connecting member 49 with a spring 59 (see Fig. 9). The spring 59 is attached to the outer connecting member 49 in a recess 66. The recess 66 holds the spring 59 with a friction fit. When an operator presses the button 20, the spring 59 is compressed and the button 20 is moved radially inwardly at least at a distal portion of the but-ton 20 and the wires 50 are disengaged from the threading of the threaded tube 18. The outer connecting member 49 comprises cams 63, which extend radially outwardly. The buttons 20 are mounted on the cams 63. Further, the outer connecting member comprises through holes 64. The wires 50 are arranged in the through holes 64. A bottom part of the U-shape is disposed in the through hole 64, while both ends of the U-shape of each wire 50 are attached to one button 20. The threaded tube 18 engages the bottom part of the U-shape.
As described with reference to the figure 7, upon rotation of the first gripping portion 15, the threaded tube 18 is rotated.
The button 20 is operatively engaged to an outer threading of the threaded tube 18 with two wires 50 (see Fig. 9).
Returning to figure 9, the wires 50 extend through the through holes 64 of the outer connecting member 49. When the threaded tube 18 is rotated, the wires 50 slip along a thread of the threaded tube 18. Thereby, the wires 50 move the second gripping portion along the axial direction of the handle portion 14.
When the button 20 is pushed radially inwardly the wires 50 are disengaged from the threading of the threaded tube 18, as they are moved out of threads of the threaded tube 18. Then, the sec-ond gripping portion 16 can be moved independently of the threaded tube 18 and the first gripping portion 15. The movement in the axial direction of the second gripping portion 16 is transferred by an inner connecting member 48 (see fig. 10) to the outer sheath 3. The inner connecting member 48 comprises a tubular body 62. The outer sheath 3 can be retracted faster with the second gripping portion 16 after pushing the button 16.
At a proximal portion of the outer sheath 3, the outer sheath 3 comprises cams 61. The cams 61 are located in a circumferential recess 58 of an inner lumen 57 of the inner connecting member 48 (see also Fig. 10B). The recess 58 allows a transfer of axial forces from the inner connecting member 48 to the outer sheath 3 over the cam 61,and allows the inner connecting member 48 to ro-tate relatively to the outer sheath 3.
Figure 10A shows a perspective view of the inner connecting mem-ber 48 and figure 10B shows a perspective view of a cross-section of the inner connecting member 48. As can be seen in the figures 9 and 10, the tubular body 62 comprises the inner lumen 57. The outer sheath 3 extends through the inner lumen 57 of the inner connecting member 48. Within the outer sheath 3 the re-straining tube 5 is arranged (see Fig. 9). The restraining tube 5 extends through the second gripping portion to a proximally disposed release mechanism 19 (see Fig. 12).
Additionally the inner connecting member 48 comprises cams 55, which extend radially outwardly. The cams 55 engage a circular recess 56 of the outer connecting member 49.
When the first gripping portion 48 and thus the threaded tube 18 are rotated, the inner connecting member 48 is rotated as well, as the cams 55 extend through the axially slotted holes 41 of the threaded tube 18. The outer sheath 3 however, is not rotat-ed, as the rotary motion is not transferred from the inner con-necting member 48 to the outer sheath 3 because of the circum-ferential recess 58. The rotary motion is neither transferred to the second gripping portion 16 because of the recess 56. The re-cess 56 only transfers axial forces from the second gripping portion to the inner connecting member and its cams 55.
As can be seen from figure 9, a cut-out in the socket 60 is shorter in axial direction than a length of the button 20 in ax-ial direction. Thus, a proximal portion of the button 20 is fix-ated to the handle portion by the socket 60. The distal portion is held by the wire 50. The spring 59 pushes the button 20 radi-ally outward. This pushes the wire 50 into the threading of the tube 18. Hence, at the same time the outer threading of the tube 18 provides a stop for the button at its distal part.
5 Figure 12 shows schematic drawings of the release mechanism 19.
In the locked position the first restraining tube 5 is fixedly attached to the body 46. The connection is formed by a lever re-alized as an arm 28. The arm 28 comprises a nose 27, which en-gages a recess in the body 46. The arm 28 is held at a pivot 69.
10 The arm 28 is rotatable around pivot 69. On the opposite of piv-ot 69 a spring 33 is arranged. The arm may also biased by two springs at each end of the arm. The spring 33 biases the arm 28 with its nose 27 into the recess of the body 46. When the opera-tor actuates the arm 28 - as indicated by arrows 34 - and press-15 es against the spring force, the nose 27 is released from the body 46. Then, the restraining tube 5 may be withdrawn in a proximal direction as indicated by arrow 35.
Figures 13A and 13B show a deployment of the endoprosthesis 2 20 with the delivery device 1 with a handle portion 14. Figure 13A
shows the endoprosthesis 2 in a compressed configuration (see fig. 2). Figure 13B shows the endoprosthesis 2 in a partially expanded configuration. When the operator is at the desired im-plantation site, the operator starts withdrawing the outer 25 sheath 3 with the first gripping portion 15. As the outer sheath 3 is withdrawn, a portion of the endoprosthesis 2, which is ar-ranged distally of the pins 13, i.e. the graft 36 and a distal part of the stent 22, starts expanding. However, while retract-ing the outer sheath 3, the proximal end 24 of the endoprosthe-30 sis 2 with its pins 13 is still held in a partially compressed configuration by the restraining tube 5. Thus, the endoprosthe-sis 2 and stent 22 are not anchored to a native vessel wall. The operator may still reposition the endoprosthesis 2, if desired.

In particular, the operator may push the endoprosthesis 2 in its proximal direction for repositioning. Once the operator is sat-isfied with the position the restraining tube 5 may be withdrawn and thus the stent 22 is released and the anchor pins 13 are de-ployed. The anchor pins 13 may then engage the vessel wall (not shown) to anchor the endoprosthesis 2.
Figures 14A and 14B show a deployment of the endoprosthesis 2 with two restraining tubes 5, 30. In contrast to the embodiment shown in figure 5, the second restraining tube 30 holds a distal portion of the stent 22. The endoluminal graft 36 is thus de-ployed before the stent 22. The stent 22 is also held in a par-tially compressed configuration by the second restraining tube 30. In this partially expanded configuration the stent 22 and the graft 36 may be repositioned.
The repositioning in the embodiment of figures 14A und 14B is easier, because the endoprosthesis is not fully in contact with a native vessel wall. The position of the stent 22 can be found more easily, since in particular the distal part of the stent 22 is not in contact with vessel wall. Thereby, an operator can even more easily reposition the stent 22 and a corresponding en-doprosthesis 2 as desired. Once the endoprosthesis 2 is at the desired implantation site, the second restraining tube 30 may be withdrawn and the position may be further be adjusted if needed, as described with reference to figures 13A and B. The restrain-ing tube 5 still holds the anchor pins 13 in a compressed con-figuration. After a retraction of the first restraining tube 5, the pins 13 are deployed in a desired potion. This procedure al-lows are very precise endoprosthesis 2 placement.
Figures 15A to 17 show a cross-sectional views and perspective views of an alternative holding mechanism for the stent 22. In the shown embodiment, the device 100 includes a harpoon member 102. The harpoon member 102 has a tubular shape and is formed as an integral cylindrical unit.
The harpoon member includes on its distal side an arm 102a and a base 102b. The arm 102a extends through an arch of the stent 22, i.e. is laced through the stent 22. A tip 101 of the catheter includes a proximal extension 106. The distal extension closes a gap between the arm 102a and the base 102b in the delivery con-figuration. As a result, the stent 107 is held securely between the arm 102a, the base 102b and the tip 101. The harpoon member 102 may include one or more recesses 120 for accommodating the struts of the stent 22. The recesses 120 may be arranged in par-ticular on a radially inner side of the arms 102a and/or on a radially outer surface, against which the struts are adapted to be pressed.
The harpoon member 102 may include one or more arms 102a. The base may have tubular form or may be formed as a tab along a part of the circumference.
When the stent is released, first the outer sheath 3 is with-drawn. When the outer sheath 3 is withdrawn, the proximal parts of the stent 22 are expanded and the stent can be positioned as described in detail above. Once the final position for the endo-prosthesis 2 is found, the harpoon member 102 is retracted in a proximal direction (see arrow 109). When the harpoon member 102 is retracted, the stent is released from the arm 102a and ex-pands such that the anchor pins 13 (see figure 2) engage a wall of a vessel of a patient.
The harpoon member 102 is held slidably within a proximal end of the tip 101. As can be seen from figures 15A to 17, the base 102b includes on its distal end a radial extension formed as flange 105. The proximal extension 106 forms together with the inner tube 4 a cavity. The base 102b is held axially slidably in the cavity. A cross-section of the entry to the cavity is small-er in cross-section than the cavity such that the harpoon member 102 can only travel a set distance. The flange 105 is larger in cross-section than the entry. Thereby, the walls of a vessel of a patient are protected from edges of the extension 106 and the harpoon member 102 cannot be lost.
A distal side 103 of the harpoon member 102 is inclined. Prefer-ably, the edges on the distal side 103 are rounded and the in-clination is below 45 . Thereby, when the catheter is retracted after the placement of the endoprosthesis 2, the walls of a ves-sel are not damaged by the distal side of the tip.

Claims

1. Delivery device (1) for an endoprosthesis (2), preferably an endoprosthesis for treating an aneurysm, comprising - an outer sheath (3), - an inner tube (4) being arranged within the outer sheath (3) and - at least one restraining tube (5) for holding the endo-prosthesis in a compressed configuration being ar-ranged between the outer sheath (3) and the inner tube (4), - wherein the outer sheath, the inner tube and the at least one restraining tube are coaxial, characterized in that, the restraining tube (5) includes at least one axial elongation (6) extending from a distal end portion of the restraining tube (5), the at least one axial elongation being adapted to be laced through portions (23) of the endoprosthesis (2).

2. Delivery device (1) according to claim 1, characterized in that at least one restraining tube (5, 30) includes multi-ple elongations (6) extending from the distal end por-tion of the restraining tube (5), preferably two or three or four or five or more elongations (6).

3. Delivery device (1) according to claim 1 or 2, further com-prising a distal tip (8) attached to a distal end (9) of the inner tube (4), wherein the distal tip (8) comprises at least one recess (10), which preferably extends circularly around the distal tip (8), wherein the at least one recess is adapted to receive at least one of the elongation(s) of a restraining tube (5, 30).

4. Delivery device (1) according to claim 3, characterized in that the at least one restraining tube (5) is releasably engageable to the distal tip (8) by engagement of at least one its elongation(s) (6) in one of the at least one re-5 cess (10) of the distal tip (8).

5. Delivery device (1) according to claim 3 or 4, characterized in that the device comprises a first and a second restrain-ing tube (5, 30) and in that the distal tip (8) comprises a 10 first recess (10) and a second recess (29), which prefera-bly extend circularly around the distal tip (8), wherein the first recess is adapted to receive at least one of the elongation(s) of the first restraining tube (5) and wherein the second recess is adapted to receive at least one of the 15 elongation(s) of the second restraining tube (30).

6. Delivery device (1) according to one of the preceding claims, characterized in that at least one of the elonga-tions (6), preferably each elongation, includes at least 20 one attachment element (11), preferably a slot (12), adapted to be engaged with a corresponding element of the endoprosthesis, in particular with an anchor pin (13).

7. Delivery device (1) according to one of the preceding 25 claims, characterized in that a first restraining tube (5) is adapted to be laced through a proximal portion, in par-ticular proximal arches, of the endoprosthesis (2).

8. Delivery device (1) according to one of the preceding 30 claims, characterized in that a second restraining tube (30) is adapted to be laced through a distal portion of the endoprosthesis (2).

9. Delivery device (1) according to one of the preceding 35 claims, characterized in that the device comprises a first and second restraining tube (5, 30), preferably only a first and a second restraining tube (5, 30).

10.Delivery device (1) according to claim 9, wherein each re-straining tube includes multiple elongations (6) extending from their respective distal end portions, wherein the elongations of the second restraining tube (30) are longer in an axial direction of the restraining tubes than the elongations of the first restraining tube (5).

11.Delivery device (1) according to claim 9 or 10, character-ized in that the first restraining tube (5) is at least partially arranged within the second restraining tube (30).

12.Delivery device (1) according to one of the preceding claims, characterized in that the elongation(s) (6) com-prise or are made of a biocompatible material, preferably metal and/or plastic, particularly preferred stainless steel or nitinol or PEEK.

13.A delivery system comprising a delivery device (1) accord-ing to one of the claims 1 to 12 and an endoprosthesis (2), wherein the endoprosthesis (2) comprises a stent (22) char-acterized in that the elongation(s) (6) of the at least one restraining tube (5, 30) are laced through portions (23) of the endoprosthesis.

14.Delivery system according to claim 13, characterized in that the stent comprises arches formed by struts (23), preferably at a proximal end (24), wherein elongations of a first restraining tube (5) are laced through the arches of the stent (22).

15.Delivery system according to claim 13 or 14, characterized in that the endoprosthesis (2) comprises a graft, wherein elongations of a second restraining tube (30) are laced through the graft of the endoprosthesis (2).

16.Delivery system according to one of the claims 13 to 15, characterized in that the elongations of a first and/or second restraining tube (5, 30) are laced through struts of the stent forming a ring.

17.Delivery system according to one of the claims 13 to 16, characterized in that the elongations of a second restrain-ing tube (5, 30) are laced through a distal part of the en-doprosthesis (2).

18.Delivery system according to one of the claims 13 to 17, characterized in that the stent (22) includes at least one anchor pin (13) and the delivery device (1) includes at least one elongation (6), wherein at least one of the elon-gation(s) (6), preferably each elongation (6), comprises one or more slots (12), wherein at least one slot (12) is operatively engaged or engageable with the at least one an-chor pin (13).

19.Delivery system according to claim 18, characterized in that characterized in that one or more anchor pins (13) are arranged on an apex, preferably a proximal apex (24), of the arches.

20.Delivery system according to one of the claims 13 to 19, characterized in that the endoprosthesis (2) includes an outer cover (36) covering a part of a stent ring and the stent ring comprises at least one repositioning open-ing (47), preferably disposed at a proximal part of the cover (36), wherein an elongation(s) of at least one re-straining tube (5, 30) is laced through the at least one repositioning opening (47).

21.Delivery device (1) for an endoprosthesis, preferably an endoprosthesis for treating an aneurysm, preferably a de-vice or system according to one of the preceding claims, comprising a handle portion (14) with - a body (46), - a first gripping portion (15) for retracting a sheath (3), preferably an outer sheath, - the first gripping portion (15) having a ring , said ring being rotatable around a longitudinal axis (L) of the body (46) such that upon rotation of the ring the sheath is withdrawn, and - a separate second gripping portion (16) for retracting the sheath, the second gripping portion being axially connected or connectable to the sheath (3), the second gripping portion (16) being slidable relatively to the body (46) along the longitudinal axis (L) of body (46) such that the sheath (3) is retractable by pulling the second gripping portion (16) longitudinally.

22.Delivery device (1) according to claim 21, wherein the han-dle portion (14) comprises an inner connecting member (48), which is rotatably connected or connectable to the second gripping portion (16) and connected or connectable to the sheath (3).

23.Delivery device (1) according to claim 22, wherein the in-ner connecting member (48) comprises one or two or more cam(s) (55), which extend(s) radially outwardly and wherein the cam(s) (55) is/are engageable in a circumferential re-cess (56) of the second gripping portion (16) or wherein the one or two or more cam(s) extend(s) radially inward from the second gripping portion and is/are engageable in a circumferential recess of the inner connecting member (48).

24.Delivery device (1) according to claim 22 or 23, wherein the inner connecting member (48) is rotatably connected or connectable to the sheath.

25.Delivery device (1) according to claim 24, wherein the in-ner connecting member (48) is tubular with an inner lumen (57) and comprises a circumferential recess (58) in the in-ner lumen (57) for receiving a cam of the sheath (3) or wherein one or two or more cams extend into the inner lumen for rotatably attaching the sheath to the inner connecting member (48).

26.Delivery device (1) according to one of the claims 21 to 25, wherein the second gripping portion (16) comprises a tubular outer connecting member (49), wherein the outer connecting member (49) is slidably arranged on a, prefera-bly threaded, tube (18).

27.Delivery device (1) according to one of the claims 21 to 26, wherein the handle portion (14) comprises a threaded tube (18), which is disposed between the second gripping portion (16), in particular a tubular outer connecting mem-ber (49), and an inner connecting member (48), wherein the second gripping portion (16) is connected or connectable to the inner connecting member (48) through axially extending slotted holes (41) in the threaded tube (18).

28.Delivery device (1) according to one of the claims 21 to 27, characterized in that the first or second gripping por-tion (14) comprises:
- a selection mechanism with a selection element, prefera-5 bly a button (20), which is moveable between an open po-sition and a locked position, the selection element preferably being biased towards the locked position, - wherein in the locked position the second gripping por-tion (16) is directly or indirectly engaged to the first 10 gripping portion (15), such that the sheath (3) is re-tractable by rotating of the first gripping portion (15) and - in the open position the second gripping portion (15) is released from the first gripping portion, such that the 15 sheath (3) is retractable by pulling the second gripping portion (16) longitudinally relatively to the body (46).

29.Delivery device (1) according to claim 28, wherein the han-dle portion comprises a threaded tube (18) which is dis-20 posed radially inwardly in relation to the second gripping portion (16), wherein the threaded tube (18) is aligned co-axially with the body of the handle portion (14), and wherein the second gripping portion (16) is indirectly en-gaged to the first gripping portion (15) via the threaded 25 tube (18) in the locked position and released from the threaded tube (18) in the open position.

30.Delivery device (1) according to claim 29, wherein the threaded tube is fixedly connected the first gripping por-30 tion (15) or integral with the first gripping portion (15).

31.Delivery device (1) according to one of the claims 28 to 30, wherein the second gripping portion comprises one or two or more radially movable contact element(s) (50), wherein the threaded tube (18) comprises an outer threading and wherein the contact element(s) (50) is/are adapted to engage the outer threading in the locked position and re-leased from the outer threading in the open position.

32.Delivery device according to claim 31, wherein the one or two or more contact element(s) (50) is/are made of wire, preferably plastic or metal wire, in particular a steel wire.

33.Delivery device according to claim 26 and claim 31 or 32, wherein the tubular outer connecting member (49) comprises one or two or more radially extending through hole(s) (64), wherein the one or two or more contact element(s) (50) is/are disposed at least partially in the one or two or more hole(s) (64).

34.Delivery device according to one of the claims 31 to 33, wherein the selection element comprises a radially movable button (20), which is operatively attached to the movable contact element(s) (50), wherein the second gripping por-tion comprises a socket (53) for holding the button (20), wherein the socket (60) comprises an inner cut-out for the button, and wherein the a length of the cut-out is shorter than a length of the button along an axial direction of the handle portion.

35.Delivery device (1) according to one of the preceding claims, characterized in that a handle portion (14) com-prises:
- at least one release mechanism (19) for releasably fix-ing a restraining tube (5, 30) to the handle por-tion (14), wherein each release mechanism (19) comprises a release element (28), preferably a button or lever, which is moveable between an open position and a locked position, wherein the release element (28) is preferably biased towards the locked position, preferably by a re-lease spring (33) and wherein in the locked position the restraining tube (5, 30) is fixedly connected to the body (46) of the handle por-tion (14), and in the open position the restraining tube (5, 30) is adapted to be axially slid longitudinally in relation to the body (46) of the handle portion (14) by retracting the restraining tube (5).

36.Delivery device according to claim 35, wherein the handle portion (14) comprises two release mechanisms for releasa-bly fixing a first and a second restraining tube (5, 30).

37.Delivery device according to claim 35 or 36, characterized in that the handle portion (14) and a restraining tube (5, 30) are connected by an actuation spring, which is pre-stressed in a longitudinal direction (L) of the handle portion (14), such that upon opening the release mechanism (19) the restraining tube (5) is retracted by the pre-stressed actuation spring (33).

38.Delivery device (1) according to one of the claims 35 to 37, characterized in that the release mechanism (19) com-prises a stopper, preferably a ring, arranged to prevent moving the release mechanism (19) from the locked position to the open position, wherein the ring is preferably dis-posed proximally to the release mechanism (19).

39.Delivery device (1) according to one of the claims 21 to 38, wherein the second gripping portion (16) is disposed proximally of the first gripping portion (15).

40.Delivery device (1) according to one of the claims 21 to 39, wherein the body (46) comprises a third gripping por-tion (51).

41.Delivery device (1) according to claim 40, wherein along a longitudinal direction (L) of the handle portion (14) the third gripping portion (51) is disposed between the first and second gripping portions (15, 16).

42.Delivery device (1) according to one of the claims 21 to 41, wherein the body (46) comprises one or two or more axi-ally extending slotted holes (54), wherein the second grip-ping portion is arranged slidably in the slotted hole(s).

43.Stent graft, preferably for treating an aneurysm, compris-ing - a collapsible and re-expandable stent (22), preferably a vascular or a heart stent, the stent (22) comprising a distal and a proximal end and at least one hole to receive a wire (31) or elongation for loading the stent (22) into a delivery device, preferably a deliv-ery device according to one of the claims 1 to 12 or 21 to 42, and - an outer cover (36) covering a distal part of the stent (22), characterized in that the at least one hole (31) is disposed proximally of a proximal edge (37) of the cover (36).

44.Stent graft according to claim 43, characterized in that the at least one hole (31) is disposed less than 2.5 mm proximally of the proximal edge of the cover (36), prefera-bly between 1 mm and 2 mm.

45.Stent graft according to claim 43 or 44, characterized in that the stent (22) includes at least one pair of struts (39) having a common apex (40) and extending from the apex in a distal direction, wherein the hole (31) is disposed at the apex (40) of the struts (39).

46.Stent graft according to claim 45, characterized in that the hole (31) is formed in between the pair of struts and includes an open end formed by the pair of struts (39), and wherein the open end is on a distal side of the hole (31).

47.Stent graft according to one of the claims 43 to 46, char-acterized in that the stent (22) comprises three or four or five or more holes (31).

48.Stent graft according to one of the claims 43 to 47, char-acterized in that the holes have a diameter of less than 1.5 mm, preferably less than 1 mm.

49.Stent graft according to one of the claims 43 to 48, char-acterized in that the proximal edge is undulating.

50.A support structure with thrombogenic elements for a stent graft, sized and shaped to be mounted on a stent graft, characterized in that the support structure comprises at least one strip of a fabric, wherein a plurality of elon-gated thrombogenic elements, preferably fibres, are at-tached to the at least one strip.

51.Support structure according to claim 50, characterized to in that the thrombogenic elements are sewn, in particular stitched, glued, welded or riveted to the at least one strip.

52.Support structure according to one of the claims 50 to 51, characterized in that the elongate thrombogenic elements comprise a first and a second end, which are attached to the strip, wherein the thrombogenic elements form a loop.

53.Support structure according to one of the claims 50 to 52, characterized in that the elongate thrombogenic elements comprise a first and a second end, wherein the first ends are connected to the strip and the second ends are releasa-bly connected to one or two or more releasable secondary strips.

54.Support structure according to one of the claims 50 to 53, characterized in that the at least one strip, preferably all strips, is formed by threads or fibres.

55.Support structure according to one of the claims 50 to 54, characterized in that the strip or the strips, in particu-lar the threads or fibres, are made of a synthetic fibre like a polyamide, PET, PE, PTFE, FEP or PFA.

56.Support structure according to one of the claims 50 to 55, characterized in that the support structure comprises only one primary strip, to which the thrombogenic elements are fixedly attached.

57.Support structure according to one of the claims 50 to 55, characterized in that the support structure comprises a plurality, preferably four, five, six, seven or more, of parallel strips which extend longitudinally are transverse-ly spaced apart, wherein the longitudinal strips are inter-connected by transversely extending strips, such that the longitudinal and the transverse strips form a mesh.

58.Support structure according to claim 57, characterized in that the support structure comprises a longitudinally ex-tending membrane which is attached to the strips.

59.Support structure according to claim 58, characterized in that the membrane is made of or comprises a plastic, pref-erably FEP or PFA.

60.Support structure according to one of the claims 57 to 59, characterized in that the thrombogenic elements are at-tached to transversely outer strips, which extend longitu-dinally.

61.Stent graft, preferably a stent graft according to one of the claims 43 to 49, comprising one or more body parts with a graft, wherein one or two or more support structures ac-cording to one of the claims 50 to 60 are arranged on a ra-dially outer surface of the graft.

62.Stent graft according to claim 61, characterized in that at least one support structure is sewn, glued or welded to the one or more body parts.

63.Stent graft according to claim 61 or 62, characterized in that at least one support structure is wound helically around the one or more body part.

64.Stent graft according to one of the claims 61 to 63, char-acterized in that a longitudinal direction of at least one support structure is parallel to a longitudinal axis of the one or more body parts.

65.Stent graft according to one of the claims 61 to 64, char-acterized in that at least one support structure is wound circumferentially around the one or more body parts.

66.Stent graft according to one of the claims 61 to 65, char-acterized in the stent graft comprises two or more body parts, wherein a first tubular body part includes a proxi-mal opening and two distal openings and a second tubular body part is attached to one of the distal openings, and wherein one or two or more support structures are attached to the first and/or second body part.

67.Stent graft according to one of the claims 61 to 66, char-acterized in that that two or more support structures, preferably four to eight support structures, are arranged on the outer surface of the one or more body parts, partic-ularly preferred on each of the body parts.